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What is suspension trauma?
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Suspension trauma, or orthostatic intolerance, is a natural human reaction to being upright and immobile, where blood pools in the legs leading to unconsciousness. It can be caused by suspension in a harness (deliberate or accidental), when trapped in a confined space, when secured to a vertical stretcher or litter - any situation where you are forced to stay upright without standing. If it is allowed to develop unchecked, it will be fatal.

What is suspension trauma?
Suspension trauma is a perfectly natural reaction caused by the body being held in an upright position. It will happen to everyone, and you do not need to be ill or injured - simply standing still and unable to fall over.
Our blood supply and heart cannot cope very well with standing up - gravity pulls blood into the tissues of our legs, and the heart cannot suck it back. Eventually, if enough blood pools in the legs, we will faint. This is fine, so long as we fall over - the blood all rushes back - but if we can't fall over, then we die.
Of course we can stand and walk about in normal life and not risk death, and this is because our leg muscles can pump the blood back upwards, provided you are able to move your legs. When we walk about, this works very well. Standing still it's less effective, and sometimes we faint. If we can't use our legs at all, such as if we're strapped into something or hanging in a harness, then we will faint. The problem comes after that - if you faint, you really need to fall over right away. Stay in the same position, and your brain has no oxygen supply. Who does it affect?
Prevention:
Preferred method—get into a sitting position as soon as possible and relax.
Plan B—put legs into stirrup (prussic) and exercise legs while in loops.
The problem with B is that when fatigue occurs and legs stop moving, the conditions creating suspension trauma are still in place.
o Try to avoid being 'upright and immobile' for more than a few minutes at a time, and if you feel ill, get out of the position straight away!
o Never leave anyone alone who may be at risk of suspension trauma.

First Aid:
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1. When rescuing, avoid hoisting in the vertical position if possible, without delaying rescue.
a. airway management with cervical spine control
b. breathing
c. circulation and hemorrhage control
3. Treat for shock
4. Secondary survey
5. All patients experiencing any symptoms of suspension trauma or exposed to high-energy falls should be admitted to hospital.

References:
O Thomassen, S C Skaiaa, G Brattebo, et al. Does the horizontal position increase risk of rescue death following suspension trauma? Emerg Med J 2009 26: 896-898.
